Homestead_Krieg (3)l '"r` 4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
f tp. STANDARD/SUPPLEMENTAL DEDUCTION FORM
L<_ "' State Fare 5473(Rl1/1ne) HCIO 2(�
�� Premised by me Department of lacy Owsmmnt Rama
INSTRUCTIONS:See reverse side for Ong nsfrWmns
NOTE:Telephone,Sodal Seaafix drivers icense,state iden65cation end federal Ident flan numbers am confidential under/C 61.1-12-37.
I(p) 11 y K•Yj s G S O certify that I(we)ocapied as my(our)
principal
place of resid er am(are)buyi foiloMng described real under contract for which a Homestead Property Tax Standard
]]�Derecordedduction is hereby claimed on the date this application is signed, (date of signature). I(We):
JO�Pwn. 0 Am(are)buying under recorded contract
❑ (are)entitled to occupy as a tenant-stockholder of a cooperative housing co/pa-attn.
❑ Have a beneficial interest In the trust er the fight to occupy the property under the terms of a qualified personal residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION - .
Ram tfsro4k spuse(boa/awns) 'Jt 'v
Sean�ooffdements%Pam(blfin ) omHt senai Ieerawation I OTv waiter d Caimans troupe WV E dart) Isstfr, .
RECORDED, _ - .. t...
•
a twist mmtat Fee Sites ovars none
Reredefs oSee vulvae centred is recorded Read garter Pegs
- -- �PROPERTV DESCRIPTIOJJ-. -p•1wr� �. _ _ •
ConeG ti i Test f t.-_�--/ —
�yPawI'wter Legs tattoo Is pWalYngIa r
Ua 'AS s ' 00-00t . ! -0oll Rearaceerti ❑ats%cussed ces hare pcbl.1-n
itany of the rb a tot tr co.eCtal ennui id t exceeding an(1)ace that ima v sraa ra that structurei re,e is Malta poha desera and Par"
an roe paean
d the Lazed n peace incase.
- PROFERTV OPINED ELSE%YHERE BY.CLAlMANT - _ �_ -�',�'
State,Casey,and Tonury -. Is claimant1, `(w a homestead?
❑ Yes rNo
Sr Wsa
I hereby certify the above statements are true correct,and complete. f
Address Can�ad(mtieer and ates. ,core.atZIP rak) -7��vao;tom ssarj (n� slate.at ZIP r) f '�r Q
r-a l t IDS <J.,. ' ('1 TO 1
ASSESSOR USE ONLY : J ASSESSED VALUE 7•-,I .HOMESTEAD'VALUE.: -;I )r t OtJ-R LESIDENTIA , '
...'.yc°
Land not exceeding one(1)acre immediately 4=:r'a ryi
surrounding residential improvements (1) 3 f --- i`Ei" >'N::
r ro
Other land (2) ^ -nT :.ct, .= teµ :
Total land(line 1 plus One 2) (3)
Residential improvements or Oweng (4) 3 � * --r e
annually rr assessed obltle/
manufactured home Garage (5) _
Other improvements (6) g.�!_,_-E-.;,'.?_z_..4_Pgy-_-
To bnprovements(line 4 through One 6) m APR 1 6 [019
Total value(litre 3 phs One 7) (a)
I hereby certify the above is true,correct, `+ °°of Assessor Hatt,mJ;Soil
and complete"
*dying "-Sinasredaafsr 'GIBSON CO Pt 1643la�dl�
• t. ._ - - - _ .. .. "STANDARD DEOUCTIOFJ ALLOIYAr CE'�<.,. . ._ "_ - "_� -_
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
NoMahffircfiog any other provision,the sum of the deductions provided in IC 61.1-12 to a noble home S
that is rot assessed as real popsy or to a manufactured home that is not assessed as teal property may
not exceed ate-ha6(1/1)of the assessed traits of the rmbb home or mamdacaued home.
Signature of Audio.' aili Date Owl(mon*claw,pear)
asiWBU110N:Origom"CanYMr�,Fle- qtl .- - ..... .
Page 1 of 2